Case for Diagnosis
Erythematous Abdominal Papule
Pápula eritematosa abdominal
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She consulted for a skin lesion that had arisen on the abdomen 8 months earlier. The lesion was asymptomatic and had not changed.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">An erythematous papule with a whitish halo, measuring 1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.5<span class="elsevierStyleHsp" style=""></span>cm diameter, was observed on the left side of the abdomen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy of the lesion revealed a proliferation of uniform, small branching vessels in the dermis. The vessels had a collapsed appearance, with a very small lumen and prominent endothelial cells. No cell atypia or mitotic figures were observed. Immunohistochemistry for herpesvirus<span class="elsevierStyleHsp" style=""></span>8 was negative (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">On dermoscopy the lesion showed diffuse central erythema with desquamation and a delicate peripheral pigment network (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Microvenular hemangioma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The excision biopsy performed at the first visit completely removed the lesion. No further treatment was required.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Microvenular hemangioma is a slow-growing, acquired benign vascular tumor that usually presents as a single erythematous papule, plaque, or nodule on the trunk or limbs of a young adult. The pathogenesis is unknown. The differential diagnosis includes benign (capillary hemangioma, pyogenic granuloma, and angioblastoma) and malignant (angiosarcoma and Kaposi sarcoma) vascular tumors and other lesions that present as erythematous-violaceous nodules, macules, or plaques that can resemble microvenular hemangioma. When multiple lesions are present, the differential diagnosis should include tumors and inflammatory lesions, such as eruptive dermatofibromas and leiomyomas, pityriasis lichenoides et varioliformis acuta, and drug eruption.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The definitive diagnosis is histological, with the finding of a proliferation of small dermal vessels formed of capillaries and venules, with no atypia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Recent studies have described the immunohistochemistry of microvenular hemangioma, which is positive for WT1 (and angiogenesis marker) and negative for D2-40 (a marker of lymphatic differentiation), GLUT-1 (specific to infantile hemangioma), and HHV-8 (positive in Kaposi sarcoma).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although dermoscopy can reveal certain peculiarities, there are few published descriptions because of the low frequency of the disease. The first description was provided by Scalvenzi et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> who reported diffuse erythema with multiple red globules of variably small size, and the presence of a fine peripheral pigment network. The red globules are defined as round structures, larger than dots.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Based on the dermoscopic findings, the differential diagnosis should include Kaposi sarcoma, which presents a classic rainbow pattern in its papular and nodular phases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, early lesions can be similar to microvenular hemangioma, with a fine peripheral pigment network and a homogeneous pinkish-red color or a homogeneous structure with reddish-blue areas; globules, characteristic of microvenular hemangioma, have not been reported. In the present case we did not observe globules, further increasing the difficulty of differentiation from Kaposi sarcoma.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The presence of erythema or small vessels, particularly when associated with a multicomponent pattern, increases the possibility of vascular tumors and malignant lesions.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The dermoscopic findings were similar to those of a variant of dermatofibroma, with a peripheral network and a homogeneously erythematous central area. To date there have been no descriptions of cases of microvenular hemangioma that mimic dermatofibroma on dermoscopy.</p><p id="par0070" class="elsevierStylePara elsevierViewall">We have presented a case of microvenular hemangioma, a rare vascular tumor with dermoscopic features that can mimic other tumors and that must be included in the differential diagnosis of vascular tumors and of nonmelanocytic lesions with a pigment network.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Morano T, Fernández-Canedo I, Fúnez-Liébana R. Pápula eritematosa abdominal. Actas Dermosifiliogr. 2016;107:62–63.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 975 "Tamanyo" => 135483 ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 271174 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>200.</p>" ] ] 2 => array:6 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 58849 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microvenular hemangioma: A clinicopathologic review of 13 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.M. Napekoski" 1 => "A.P. Fernandez" 2 => "S.D. Billings" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cup.12386" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2014" "volumen" => "41" "paginaInicial" => "816" "paginaFinal" => "822" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25263662" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microvenular hemangioma-an immunohistochemical study of 9 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Trindade" 1 => "H. Kutzner" 2 => "L. Requena" 3 => "O. Tellechea" 4 => "I. Colmenero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e31824d2c27" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2012" "volumen" => "34" "paginaInicial" => "810" "paginaFinal" => "812" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23169416" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of microvenular hemangioma: Report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Scalvenzi" 1 => "F. de Natale" 2 => "M.G. Francia" 3 => "A. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 6 | 28 |
| 2024 Octubre | 179 | 55 | 234 |
| 2024 Septiembre | 213 | 24 | 237 |
| 2024 Agosto | 206 | 74 | 280 |
| 2024 Julio | 189 | 52 | 241 |
| 2024 Junio | 129 | 43 | 172 |
| 2024 Mayo | 124 | 43 | 167 |
| 2024 Abril | 144 | 30 | 174 |
| 2024 Marzo | 196 | 20 | 216 |
| 2024 Febrero | 194 | 33 | 227 |
| 2024 Enero | 177 | 32 | 209 |
| 2023 Diciembre | 144 | 18 | 162 |
| 2023 Noviembre | 138 | 33 | 171 |
| 2023 Octubre | 111 | 22 | 133 |
| 2023 Septiembre | 128 | 26 | 154 |
| 2023 Agosto | 121 | 19 | 140 |
| 2023 Julio | 119 | 27 | 146 |
| 2023 Junio | 118 | 22 | 140 |
| 2023 Mayo | 84 | 23 | 107 |
| 2023 Abril | 103 | 23 | 126 |
| 2023 Marzo | 101 | 25 | 126 |
| 2023 Febrero | 110 | 32 | 142 |
| 2023 Enero | 110 | 44 | 154 |
| 2022 Diciembre | 94 | 51 | 145 |
| 2022 Noviembre | 39 | 26 | 65 |
| 2022 Octubre | 29 | 22 | 51 |
| 2022 Septiembre | 22 | 40 | 62 |
| 2022 Agosto | 19 | 22 | 41 |
| 2022 Julio | 47 | 29 | 76 |
| 2022 Junio | 33 | 24 | 57 |
| 2022 Mayo | 111 | 34 | 145 |
| 2022 Abril | 115 | 34 | 149 |
| 2022 Marzo | 93 | 45 | 138 |
| 2022 Febrero | 117 | 27 | 144 |
| 2022 Enero | 117 | 43 | 160 |
| 2021 Diciembre | 102 | 30 | 132 |
| 2021 Noviembre | 104 | 42 | 146 |
| 2021 Octubre | 90 | 47 | 137 |
| 2021 Septiembre | 79 | 39 | 118 |
| 2021 Agosto | 85 | 35 | 120 |
| 2021 Julio | 69 | 32 | 101 |
| 2021 Junio | 81 | 36 | 117 |
| 2021 Mayo | 83 | 33 | 116 |
| 2021 Abril | 265 | 63 | 328 |
| 2021 Marzo | 190 | 16 | 206 |
| 2021 Febrero | 158 | 28 | 186 |
| 2021 Enero | 69 | 15 | 84 |
| 2020 Diciembre | 68 | 20 | 88 |
| 2020 Noviembre | 59 | 34 | 93 |
| 2020 Octubre | 57 | 21 | 78 |
| 2020 Septiembre | 50 | 21 | 71 |
| 2020 Agosto | 40 | 17 | 57 |
| 2020 Julio | 48 | 18 | 66 |
| 2020 Junio | 33 | 32 | 65 |
| 2020 Mayo | 31 | 23 | 54 |
| 2020 Abril | 42 | 21 | 63 |
| 2020 Marzo | 30 | 21 | 51 |
| 2020 Febrero | 7 | 1 | 8 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 10 | 1 | 11 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 6 | 1 | 7 |
| 2019 Abril | 2 | 3 | 5 |
| 2019 Marzo | 4 | 1 | 5 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 18 | 0 | 18 |
| 2018 Septiembre | 7 | 0 | 7 |
| 2018 Junio | 0 | 5 | 5 |
| 2018 Mayo | 0 | 14 | 14 |
| 2018 Abril | 0 | 8 | 8 |
| 2018 Marzo | 8 | 6 | 14 |
| 2018 Febrero | 62 | 5 | 67 |
| 2018 Enero | 52 | 6 | 58 |
| 2017 Diciembre | 92 | 8 | 100 |
| 2017 Noviembre | 20 | 4 | 24 |
| 2017 Octubre | 33 | 6 | 39 |
| 2017 Septiembre | 32 | 4 | 36 |
| 2017 Agosto | 30 | 8 | 38 |
| 2017 Julio | 28 | 9 | 37 |
| 2017 Junio | 35 | 10 | 45 |
| 2017 Mayo | 39 | 9 | 48 |
| 2017 Abril | 39 | 15 | 54 |
| 2017 Marzo | 18 | 8 | 26 |
| 2017 Febrero | 17 | 18 | 35 |
| 2017 Enero | 25 | 10 | 35 |
| 2016 Diciembre | 40 | 11 | 51 |
| 2016 Noviembre | 36 | 13 | 49 |
| 2016 Octubre | 22 | 28 | 50 |
| 2016 Septiembre | 0 | 2 | 2 |
| 2016 Agosto | 0 | 2 | 2 |
| 2016 Julio | 0 | 1 | 1 |
| 2016 Junio | 0 | 1 | 1 |
| 2016 Mayo | 0 | 4 | 4 |
| 2016 Abril | 0 | 2 | 2 |
| 2016 Marzo | 0 | 14 | 14 |
| 2016 Febrero | 0 | 1 | 1 |
| 2016 Enero | 0 | 4 | 4 |
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